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Pesticides and Maternal Child Health, Experience and the Construction of Knowledge Among the Huichol

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Pesticides and Maternal Child Health, Experience and the Construction of Knowledge Among the Huichol Pesticides and maternal child health, experience and the construction of knowledge among the Huichol Jennifer Bridget Gamlin Institute of Global Health University College London Supervisor: Dr. Sarah Hawkes A thesis submitted for the degree of Doctor of Philosophy June 2013 1 Declaration I Jennifer Bridget Gamlin confirm that the work presented in this thesis is my own. Where information has been derived from other sources I confirm that this has been indicated in the thesis. 2 Abstract Pesticides can be harmful to the reproductive process and even low dose exposures can lead to miscarriage, developmental delays and birth defects. Huichol indians from the Sierra Madre highlands in northern Mexico supplement their subsistence lifestyle with annual migration to coastal tobacco farms, where they are exposed to the many pesticides that are used in the production process. The specific working and living conditions that they experience combined with cultural, economic and social factors ensure that this group of workers are particularly at risk to the effects of pesticides. This thesis will discuss how these migrant labourers understand their reproductive, maternal and child health outcomes considering the context within which they live and work, in particular their exposure to pesticides, traditional beliefs about health and their knowledge and practices relating to maternal and child health. Using ethnographic data and drawing largely on interpretative and critical medical anthropology this thesis will explore how supernatural understandings of illness causality, experiences as migrant labourers and their indigenous world view affect their understanding of the risks of pesticides. Underlying the central problems of their health are social, political, racial and economic conditions that have structured the way in which this population lives and works, ensuring that they are in harm’s way both as migrants and while living at home in the highlands. The thesis concludes that the greatest determinants of their knowledge and practices are historical and on-going forms of structural and everyday violence, mediated through their beliefs in supernatural causality. 3 Acknowledgements Throughout the long process of researching and writing this thesis I was helped and supported by very many people. As well as thanking them for their support, I would like to acknowledge their contributions to the content and product of my research. I have been fortunate to have been guided in this process by five different academic supervisors. Firstly I would like to thank Professor Nanneke Redclift whose enthusiasm and shared fascination with Mexico helped form the original research ideas. Many thanks also to Dr. Sarah Hawkes and Dr. Joe Calabrese for their supervision and encouragement, particularly at the writing stage. Finally thanks also to Professor Therese Hesketh and Dr. David Osrin who supported me in the early stages of this PhD. There are many people in Mexico without whom this research would have been impossible. Very deep thanks must go to the community of Santa Catarina/Tuapurie for allowing and enabling me to conduct this study. Thanks also to every one of my informants in Santiago and in the Sierra for sharing their time, homes, lives and often personal and intimate experiences with me. Very deep thanks go to Totupica Candelario, who so very patiently tried to teach me Huichol, introduced me to many kind people and patiently waited while my aching feet and jelly legs recovered from hours of climbing. Thanks also go to my assistants Juan and Rosa and to Don Antonio for accompanying, translating and sensitively managing a delicate relationship as intermediaries between myself and the governorship of Tuapurie. Finally also to Patricia Díaz Romo, Doctora Carmen, Dr. Horacia Fajardo and to Dr. Rene Crocker for facilitating my fieldwork in the Sierra. In Santiago I am indebted to Federico Langarica for the many hours he spent driving myself and my assistants from one dusty plantation to another, as well 4 as for his wisdom about tobacco production in Nayarit. Thanks also to staff at the Florece centres in Santiago for help locating Tuapuritari as well as to PRONJAG staff in Tepic for granting me access to their data and facilities. In Mexico City I must thank Professor Eduardo Menéndez for inviting me to CIESAS as an honorary research fellow and to all members of the Permanent Seminar on Medical Anthropology for advising me on my research process. Back in London thanks must go to my supportive colleagues, to Dr.Mary Wickenden for informal advice, to Madeleine Green for proof reading and dealing with piles of illegible Mexican receipts and to Dr. Audrey Prost for participating in my upgrade and later advice on chapters. Finally thanks my Mum for taking on the laborious tasks of typing up my field diaries and proof reading my entire PhD, also for taking my children during holidays so that I could write. Most of all thanks to Carlos, Lucio and Artemio for just about everything else that I have needed to write this thesis! This research was funded with a multidisciplinary ESRC/MRC studentship. My thanks go to both research councils. 5 Table of Contents Chapter 1 Introduction......................................................................................... 19 1.1 Rationale...................................................................................................21 Chapter 21.2Methods.Background.............................................................................................................................................................................................5438 2.1 Ethical approval.....................................................................................54 2.2 Data collection and sample identification ...................................56 2.3 Methods ....................................................................................................63 2.4 Reflexivity ................................................................................................74 Chapter 32.5Context.Limitati................................ons................................................................................................................................................................. 8977 3.1 Framework for the determinants of reproductive health.....90 3.2 Distal determinants: Mexico and the context of structural violence.....................................................................................................93 3.3 Intermediate determinants: community and culture, beliefs, spirituality, environment. ............................................... 107 3.4 Proximal/individual determinants............................................. 117 Chapter 43.5KnowledgeKey proximal about determinahealth andnts pesticides:................................ an ........................... 126 interpositional theoretical approach. ......................................143 4.1 Indigenous health and pesticide risk: is structural violence implicit? ............................................................................... 144 4.2 The Health Beliefs Model and beliefs about pesticide harm........................................................................................................ 151 4.3 Medical anthropology ......................................................................154 4.4 Conclusion ............................................................................................ 173 Chapter 5 ‘Nobody has anything in Taimarita’ Tuapuritari ethnomedicine and medical syncretism.................................175 5.1 Introduction ......................................................................................... 175 5.2 Experiences and attitudes, knowledge and beliefs, practices and norms regarding modern health care and provision in the Sierra and on the coast ...................................176 6 5.3 Knowledge and practices of migrant workers........................ 179 5.4 Ethnomedicine and medical syncretism...................................190 5.5 Conclusions: a specific form of medical syncretism............. 204 Chapter 6 ‘Don’t let children wander at fiestas’ Reproductive and maternal child health: knowledge/beliefs, practices and problems. ................................................................208 6.1 Understandings: knowledge/beliefs about maternal and reproductive health .......................................................................... 210 6.2 Practices in pregnancy and birth................................................. 213 6.3 The mara’akame in maternal health........................................... 216 6.4 Pregnancy and migrant labouring............................................... 218 6.5 Births ......................................................................................................221 6.6 Health beliefs or structural violence? ........................................ 225 6.7 When things go wrong: infant death, miscarriage and congenital malformations............................................................... 229 Chapter 76.8‘WhatConclusions: can you do? gender, We have shame to work!’ and costumbreTobacco........................... 244 production, pesticides and experience. ...................................249 Tet+ata 7.1 Tobacco production in .................................................... 251 7.2 Pesticide use in the sierra............................................................... 259 7.3 Huichol workers’
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